URLNPUnilateral Recurrent Laryngeal Nerve Paralysis
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In our study, we estimated that performing less radical surgery in NTMNG was associated with a significantly lower risk of early and late URLNP and OT, than in more radical procedures.
Type of surgery Complications [Chi.sup.2] Yes No P RLNP TT 18 (2.07%) 849 STT 5 (1.07%) 459 <0.01 DO 2 (0.28%) 699 OT TT 42 (4.84%) 825 STT 6 (1.29%) 458 <0.0001 DO 9 (1.28%) 692 POB TT 11 (1.26%) 856 STT 4 (0.86%) 460 0.209 DO 3 (0.42%) 698 Total TT 71 (8.18%) 796 complications STT 15 (3.23%) 449 <0.0001 DO 14 (1.99%) 687 Type of surgery URLNP P RLNP TT 15 (1.73%) 852 STT 3 (0.64%) 461 <0.05 DO 2 (0.28%) 699 OT TT STT DO POB TT STT DO Total TT complications STT DO Type of surgery BRLNP P RLNP TT 3 (0.34%) 864 STT 2 (0.43%) 460 0.25 DO 0 (0.0%) 701 OT TT STT DO POB TT STT DO Total TT complications STT DO Table 3: Persistent complications, evaluated six months postoperatively.
[9] The technique is now known as the Isshiki type I procedure (the other procedures described by Isshiki are not employed for treating URLNP).
The technique seems to have less favorable results in cases of long-standing URLNP due to muscular atrophy and fibrosis.
In 1991, Mikaelian et al were the first to report the use of autologous fat to treat glottic incompetence in URLNP. [86] Fat is harvested from the thigh or abdomen using a cutaneous incision or lipoaspiration under local or general anesthesia.
Autologous fat has been routinely employed with success in treating aspiration due to URLNP. [65,87] Excellent vocal results have also been reported.
URLNP may cause aspiration, mainly of liquids, which occurs during the pharyngeal phase of swallowing.
All the intrinsic laryngeal muscles are affected by URLNP except for the IA, which is bilaterally innervated, and the CT, which is innervated by the external branch of the SLN.
Hoffman and McCulloch have described two types of glottic incompetence during phonation in URLNP. [45] The first is incomplete closure along the membranous VC only, with an elliptical gap and no posterior glottic gap.
Voicing is sometimes of such poor quality in URLNP that detection of the F0, and thus stroboscopy, is impossible.
The aim of this review article is to relate current concepts in laryngeal physiology and neurophysiology and to summarize current therapeutic options for URLNP.
Aspiration due to recurrent laryngeal nerve paralysis occurs generally during the pharyngeal phase due to insufficient laryngeal occlusion, but abnormalities in upper esophageal sphincter tone and relaxation have been documented in URLNP. [6]